瑞舒伐他汀联合维生素C对维持性血液透析患者微炎症反应的影响

Effect of Rosuvastatin combined with vitamin C on the microinflammation response of maintenance hemodialysis patients

目的 探讨瑞舒伐他汀联合维生素C对维持性血液透析（MHD）患者微炎症状态的影响.方法 将2010年12月～2013年1月芜湖市第二人民医院肾内科收治的行MHD的42例慢性肾衰竭（CRF）患者按随机数字表格法分为观察组和对照组,每组各21例,两组均给予维生素C进行干预,观察组在对照组用药基础上加用瑞舒伐他汀钙片,检测两组患者血清炎症因子[白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（hs-CRP）]、营养指标[前白蛋白（PA）、转铁蛋白（TF）,血清白蛋白（ALB）]、血脂水平[三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）]及肾功能指标[血尿素氮（BUN）、血肌酐（Cr）],并评价其心功能[室间隔舒张末厚度（IVST）、左心室重量指数（LVMI）、左心室重量（LVM）].结果 观察组治疗后血清hs-CRP、IL-6、TNF-α水平依次为（5.08±0.74）mg/L、（7.71±1.02）ng/L、（1.15±0.11）ng/L,均明显低于对照组相应的（7.02± 1.02）mg/L、（11.61±1.12）ng/L、（1.84±0.15）ng/L,差异有统计学意义（t=7.268、13.254、15.463,均P＜0.05）;TG、TC、LDL-C分别为较对照组明显降低（t=4.191、3.833、6.484,均P＜0.05）,HDL-C较对照组明显升高（t=3.218,P＜0.05）,两组BUN、Cr治疗前后及组间比较差异均无统计学意义（P＞0.05）;治疗后观察组患者的LVM、LVMI及IVST指标分别为（160.15±21.42）g、（94.05±20.70）g/m、（9.20±0.32）mm,均较治疗前明显降低,差异有统计学意义（t=4.712、3.798、7.660,均P＜0.05）,而对照组治疗前后无明显变化（P＞0.05）.结论 瑞舒伐他汀联合维生素C能有效改善MHD患者微炎症反应及营养状况,保护患者心功能.

Objective To investigate the effect of Rosuvastatin combined with vitamin C on the microinflammation response of maintenance hemodialysis （MHD） patients.Methods 42 cases of MHD with chronic renal failure （CRF） patients admitted to Department of Nephrology of the Second People＇s Hospital of Wuhu City from December 2010 to January 2013 were divided into observation group and control group with 21 cases in each group according to the random number table method.The two groups were given vitamin C to intervene.The observation group was added with Rosuvastatin Calcium on the basis of the control group.Serum levels of inflammatory cytokines [interleukin-6 （IL-6）,tumor necrosis factor-alpha （TNF-α）,C-reaction protein （hs-CRP）],nutritional indicators [prealbumin （PA）,transferrin （TF）,serum albumin （ALB）],lipid levels [triglycerides （TG）,total cholesterol （TC）,high density lipoprotein cholesterol （HDL-C）,low-density lipoprotein cholesterol （LDL-C）] and renal function parameters [blood urea nitrogen （BUN）,serum creatinine （Cr）] were detected,and cardiac function [end-diastolic ventricular septal thickness （IVST）,left ventricular mass index （LVMI）,left ventricular mass （LVM）] were evaluated.Results After treatment,serum hs-CRP,IL-6,TNF-α level were （5.08±0.74） mg/L,（7.71±1.02） rng/L,（1.15±0.11） ng/L in observation group,which were significantly lower than those in the control group with the value of （7.02±1.02） mg/L,（11.61±1.12） ng/L,（1.84±0.15） ng/L,the differences were statistically significant （t =7.268,13.254,15.463,all P ＜ 0.05）.The levels of TG,TC,LDL-C were significantly lower than the control group （t =4.191,3.833,6.484,all P ＜ 0.05）,the level of HDL-C was significantly higher than the control group （t =3.218,P ＜ 0.05）.Compared with before treatment,after treatment,observation group of patients with LVM,LVMI and IVST indicators [（160.15±21.42） g,（94.05±20.70） g/m,（9.20±0.32） mm] were significantly reduced,the differences were statistically significant （t =4.712,3.798,7.660,all P ＜ 0.05）,while no significant changes occured in the control group before and after treatment （P ＞ 0.05）.Conclusion Rosuvastatin joint vitamin C can effectively improve micro-inflammation reaction and nutritional status in patients with MHD,can protect the cardiac function in patients.